Employer'S Withholding Registration Form

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CITY OF PONTIAC - DIRECTOR OF FINANCE - INCOME TAX DIVISION
EMPLOYER'S FEDERAL IDENTIFICATION NUMBER
(IF NOT REQUIRED - WRITE "NONE")
EMPLOYER'S WITHHOLDING REGISTRATION
READ INSTRUCTIONS ON THE REVERSE BEFORE FILLING OUT THIS FORM
P
-
1. TRADE NAME
2. EMPLOYER'S NAME:
(GIVE OWNER'S TRUE NAME IF DIFFERENT FROM TRADE NAME ABOVE)
3. ADDRESS OF PRINCIPAL PLACE OF BUSINESS
4. CHECK TYPE OF ORGANIZATION
OTHER
5. LOCAL TELEPHONE #
6. NO. OF EMPLOYEES
INDIVIDUAL OWNER
PARTNERSHIP
CORPORATION
(ATTACH EXPLANATION)
7. DATE BUSINESS ACQUIRED BY
MONTH
DAY
YEAR
8. GIVE THE DATE YOU FIRST PAID WAGES
MONTH
DAY
YEAR
EMPLOYER SHOWN IN ITEM 2 ABOVE
SUBJECT TO PONTIAC WITHHOLDING
9. WAS THIS BUSINESS PREVIOUSLY OPERATED BY ANOTHER EMPLOYER?
10. IF ANSWER TO ITEM 9 IS "YES", GIVE EMPLOYER'S NAME AND IDENTIFICATION # IF KNOWN.
YES
NO
SIGNATURE
TITLE
DATE
P-SS-4
INSTRUCTIONS
Each employer withholding City of Pontiac Income Tax from employees' wages should register immediately with the
Director of Finance, Income Tax Division. For the convenience of the employer, the Federal Employer Identification Number
(FEIN) assigned to the employer by the Internal Revenue Service will be used for the City of Pontiac Income Tax Division
records. If an employer does not have a FEIN at the time of filing the City of Pontiac Income Tax Reports, application can
be made to the Internal Revenue Service on Federal Form SS-4 for a number.
When, for any reason, the FEIN is not required, an identification number will be assigned by the City of Pontiac Income
Tax Division. If an employer is assigned a FEIN at a later date, he must notify the City Income Tax Division of the FEIN
assigned. The employer will then be notified to discontinue the City of Pontiac Identification Number and use the FEIN for
all future City withholding purposes.
Read the instructions for withholding in the City of Pontiac Income Tax Withholding Guide.
Return this form to: City of Pontiac Income Tax Division; P.O. Box 530; Eaton Rapids, MI 48827-0530

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